Bleb reconstruction using donor scleral patch graft for late bleb leak and hypotony. Issue 3 (May 2021)

• Record Type: Journal Article
• Authors: O'Rourke, Michael; Moran, Sarah; Collins, Niamh; Doyle, Aoife
• Is Part Of: European journal of ophthalmology. Volume 31:Issue 3(2021)
• Page Start: 1039
• Page End: 1046
• Publication Date: 2021-05
• Subjects: Cornea/external disease -- glaucoma -- glaucoma incisional surgery -- lens/cataract -- post-operative glaucoma/hypotony -- scleral degenerations -- surgery with high-risk ocular conditions; Ophthalmology -- Periodicals; Eye -- Diseases -- Periodicals; 617.7005
• DOI: 10.1177/1120672120924343
• Languages: English
• ISSNs: 1120-6721

Abstract

Purpose: Bleb dysfunction may occur as a late complication following glaucoma filtration surgery. Over-filtering, thinning and cystic blebs can lead to hypotony, leak and corneal dellen. We report our surgical management and outcomes of this specific entity using donor scleral patch grafts. Methods: This is a 10-year non-comparative, retrospective interventional case series. Bleb reconstruction involved excision of encysted conjunctiva and sclera to identify the original fistula. A functioning donor scleral patch graft was sited over this with fixed and releasable sutures and the conjunctiva advanced. Intraocular pressure, visual acuity and post-operative issues were assessed. Results: A total of 18 eyes of 17 patients with mean age 65 years (standard deviation 13.5) were included. Trabeculectomy was the primary procedure in 72% ( n = 13) and deep sclerectomy in 28% ( n = 5). Bleb leak accounted for 61% ( n = 11), hypotony 33% ( n = 6) and corneal dellen 6% ( n = 1). Mean pre-operative intraocular pressure was 7 mm Hg (standard deviation 4.6) which increased to 18.5 mm Hg (standard deviation 12) at day 1 ( p < 0.001), 11.8 mm Hg (standard deviation 4.6) at 3 months ( p < 0.05), 12.1 mm Hg (standard deviation 4.2) at 1 year ( p < 0.01) which was maintained at 12.1 mm Hg (standard deviation 5.3) at last follow-up ( p < 0.001). Post-operative interventions included bleb needling, re-suturing, suture removal, further glaucoma management, bleb leak and cataract surgery. Visual acuity also improved post-operatively and was maintained. Conclusion: Reconstruction of the filtering bleb architecture with donor sclera results in improved intraocular pressure while maintaining visual acuity. Post-operative care is required to support the restored bleb function. Our findings support the use of scleral patch graft as an effective and safe method for the long-term management of hypotony and bleb leak as a late complication of glaucoma filtration surgery.